Department of Neurology, the Ural State Medical University, Repina 3, Yekaterinburg, 620028, Russia.
International Headache Center "Europe-Asia", Yekaterinburg, Russia.
J Headache Pain. 2022 Aug 17;23(1):103. doi: 10.1186/s10194-022-01479-9.
It is poorly described how often headache attributed to stroke continues for more than 3 months, i.e. fulfils the criteria for persistent headache attributed to ischemic stroke. Our aims were: 1) to determine the incidence of persistent headache attributed to past first-ever ischemic stroke (International headache society categories 6.1.1.2); 2) to describe their characteristics and acute treatment; 3) to analyse the prevalence of medication overuse headache in patients with persistent headache after stroke; 4) to evaluate factors associated with the development of persistent headache after stroke.
The study population consisted of 550 patients (mean age 63.1, 54% males) with first-ever ischemic stroke, among them 529 patients were followed up at least three months after stroke. Standardized semi-structured interview forms were used to evaluate these headaches during professional face-to-face interviews at stroke onset and telephone interviews at 3 months.
At three months, 61 patients (30 women and 31 men, the mean age 60.0) of 529 (11.5%) follow-up patients had a headache after stroke: 34 had a new type of headache, 21 had a headache with altered characteristics and 6 patients had a headache without any changes. Therefore 55 (10.4%) patients had a persistent headache attributed to ischemic stroke. Their clinical features included: less severity of accompanying symptoms, slowly decreasing frequency and development of medication overuse headache in one-third of the patients. The following factors were associated with these headaches: lack of sleep (29.1%, p = 0.009; OR 2.3; 95% CI 1.2-4.3), infarct in cerebellum (18.2%, p = 0.003; OR 3.0; 95% CI 1.4-6.6), stroke of undetermined etiology (50.9%, p = 0.003; OR 2.3; 95% CI 1.3-4.1), less than 8 points by NIHSS score (90.9%, p = 0.007; OR 3.4; 95% CI 1.4-8.6) and low prevalence of large-artery atherosclerosis (12.7%, p = 0.006; OR 0.3; 95% CI 0.2-0.80).
Persistent headache attributed to ischemic stroke is not rare and frequently leads to medication overuse. The problem is often neglected because of other serious consequences of stroke but actually, it has a considerable impact on quality of life. It should be a focus of interest in the follow-up of stroke patients.
头痛归因于中风持续超过 3 个月的情况（国际头痛协会类别 6.1.1.2）并不常见，即符合缺血性中风后持续性头痛的标准。我们的目的是：1）确定过去首次缺血性中风后持续性头痛的发生率（国际头痛协会类别 6.1.1.2）；2）描述其特征和急性治疗；3）分析中风后持续性头痛患者中药物过度使用性头痛的患病率；4）评估与中风后持续性头痛发展相关的因素。
研究人群包括 550 例首次缺血性中风患者（平均年龄 63.1 岁，54%为男性），其中 529 例在中风后至少随访 3 个月。在中风发作时使用标准化半结构化访谈表进行专业面对面访谈，并在 3 个月时进行电话访谈，以评估这些头痛。
在 3 个月时，529 例随访患者中有 61 例（30 名女性和 31 名男性，平均年龄 60.0 岁）出现中风后头痛：34 例出现新类型头痛，21 例出现头痛特征改变，6 例头痛无变化。因此，55 例（10.4%）患者出现缺血性中风后持续性头痛。他们的临床特征包括：伴随症状的严重程度较轻，头痛频率逐渐降低，三分之一的患者出现药物过度使用性头痛。以下因素与这些头痛相关：睡眠不足（29.1%，p=0.009；OR 2.3；95%CI 1.2-4.3）、小脑梗死（18.2%，p=0.003；OR 3.0；95%CI 1.4-6.6）、病因不明的中风（50.9%，p=0.003；OR 2.3；95%CI 1.3-4.1）、NIHSS 评分低于 8 分（90.9%，p=0.007；OR 3.4；95%CI 1.4-8.6）和大动脉粥样硬化发生率低（12.7%，p=0.006；OR 0.3；95%CI 0.2-0.80）。
缺血性中风后持续性头痛并不罕见，常导致药物过度使用。由于中风的其他严重后果，这个问题往往被忽视，但实际上它对生活质量有相当大的影响。它应该成为中风患者随访的关注焦点。
